Q&A talks about the state of family medicine with Dr. Ross Winakor, the new president of the Connecticut Academy of Family Physicians.
Q: You’re the newly elected president of the CT Academy of Family Physicians. What is the academy and what does it do?
A: The CT Academy of Physicians is the state chapter of American Academy of Family Physicians. It represents the majority of family physicians in the state, with practicing clinicians, residents and students alike who are training in the state. The academy helps with advocacy to keep a voice and seat at the table and keep pressure on public policy and to disseminate information to practicing physicians. It also works on continuing the education of students and physicians and to supporting the many practice need of the family physicians in our state.
Q: The idea of family physicians seems to be old fashion. Are younger doctors going into the profession or is there a greater trend towards doctors working for hospitals?
A: There are a lot of different trends. Family physicians as a specialty is fairly young. It’s only been around the last 50 years. But we are seeing a trend of physicians going into more sub-specialty fields like surgery or hospitalists. There are a lot of reasons, many of which are economic. Insurance reimbursements are currently mainly based on procedures and volumes — so called, quantity versus quality. The more procedures you do, injections, surgery, and the more patients you see, the potentially higher reimbursement. What’s not in that equation is the many cognitive skills family physicians possess and offer. For example, a family physician might spend 30 minutes with a patient discussing treatment options for a variety of complex medical conditions. A procedure is reimbursed at a higher rate than then maintaining the control and quality of care of populations of complex co-morbid conditions. Many specialists earn three to five times what family physicians do. Medical students often come out of school with six-figure debt. They have to take that into consideration when choosing a specialty. Generally many students and trainees see the family physician doing much more paperwork and dealing with chronic problems and getting paid less to do it.
Q: What’s the biggest challenge facing the academy and its members? What threatens the group as a profession?
A: One of the biggest challenges we see in Connecticut and the nation is workforce shortages. There are generally not enough family and primary care physicians. We need more in the trenches to take care of people. The population is aging. Some people will say there are plenty of physicians but they are not distributed geographically in a way that makes sense. Also, it’s a question of lifestyle, too, because medicine is not a 9 to 5 job. A hospitalist is more a scheduled profession. You’re taking care of the patients while they’re in the hospital but not before or after. From a patient care standpoint, there’s the loss of continuity of care of the patient and fragmentation because different people are taking care of the patient.
One of the other big pushes is we’re seeing for information technology. Many are ahead of and some riding the curve but many aren’t. Many family physicians are small business owners. Imagine trying to run a small business while your expenses are increasing and your reimbursements aren’t and in some cases your reimbursements are shrinking both in real dollars and when priced for inflation. This is not a recipe for success.
Q: One issue important to the academy is medical malpractice and specifically the certificate of merit, which helps weed out frivolous lawsuits. What are the odds of that legislation coming up again this session?
A: Certificate of Merit is a program to help minimize frivolous lawsuits. In our society, anybody can sue anybody. To get to the next level, there has to be somebody that reviews the suit to see if there is some merit to the lawsuit proceeding. Connecticut has not jumped over the hurdle of enacting meaningful tort reform. Negligence is a concern in any profession but the catch basins and concerns of frivolous lawsuits is real and potentially large. Many malpractice lawsuits are ultimately dismissed or end up with a judgment in favor of the physician but the time, expense and personal loss in these situations is large. A lot of us in the trenches are practicing defensive medicine to help reduce liability concerns. I think the odds are high of medical malpractice coming up again.
Q: What other concerns does the academy have going into the upcoming session? What issues will your group be on the lookout for when the legislature convenes next month?
A: We will also be looking at scope of practice issues. Some people think a solution is simply having more non-physician clinicians such as nurse practitioners providing medical care. They will be going to the legislature to open up their scope of practice to allow them to do more and be less dependent on physicians and in fact attempting to become independent providers. We’re concerned. We think medicine is a team effort but physicians and physicians only should be leaders of those teams. Many nurse practitioners and physician assistants are excellent and important members of the team but not necessarily qualified to lead that team. Their training and hence experience is a fraction of a family physician.
Q: Among the issues your group is advocating for at the State Capitol has to do with vaccines. Why is this a public health issue? What is the academy hoping to accomplish?
A: There have been recent and continued changes in vaccine for children programs. Many vaccines are funded by the federal and state governments. In Connecticut, it has gone through some evolutions and most of the changes relate to where vaccinations come from and reimbursements. Many physicians have two sets of vaccines. One from the state was for children who were uninsured or underinsured. Clinicians also had to purchase vaccines at their own cost for people with private insurance. Legislators and the insurance industry did not feel that was a good system. Going forward as of Jan. 1, 2013 most of the state-mandated and highly recommended vaccines will be provided by the state and dispensed to the physicians for administration. The old system worked pretty well. The state of Connecticut is in the Top 5 of “healthiest states” and part of this is that 99 percent of children by the time they reach 5 are appropriately immunized. Many physicians feel if it’s not broken as evidenced by this high immunization rate then why fix it? The state has also had problems with supply chain and shortage issues in the past and one of the logical worries is that this will get worse. If a vaccine is missed because of a shortage of supply chain issue, it is often 2-3 times harder to get that child back into the office at a later date to “catch up.”
